Botox - Dr Joanna Gach - Consultant Dermatologist


BOTOX® is the commercial tradename for Botulinum Toxin Type A.

Botox is well known as a non-surgical treatment for expressive facial wrinkles. It complements the rejuvenating effect of dermal fillers very well.

Botox is a drug that blocks the action of acetycholine at the neuromuscular junction causing weakness of a nearby muscle. It is a safe and effective treatment and is administered by several small injections. The effect is visible within a few days to 2 weeks and tends to wear off by approximately 4 months.

Your expectations will be discussed before the treatment and your face will be fully examined prior to procedure.

Botox also affects the neuroglandular junction of sweat glands and therefore can work very well for excessive sweating.

Treatment is offered for:

Skin Peels

There are three types of skin peels available and they are used to achieve different results.

Superficial chemical peels (for example glycolic acid) are easy to apply and the time needed for healing is minimal, but they won’t achieve long-lasting or dramatic results.

Medium chemical peels (like trichloroacetic acid/TCA) can achieve more dramatic and long-lasting results for blemishes, fine lines and facial scarring.

A deep peel will help reduce more severe facial wrinkles, but carry a higher risk of producing post inflammatory pigmentation and scarring.

The peel is applied to your face for a set period of time. Following the procedure, your face will be red and sensitive. The length of time it will take to recover will depend on the type of peel you have had and sensitivity of your skin. After a medium or deep peel, it can take a couple of weeks before you can go back to normal activities but even after this time, your skin could still be quite red.

As your skin heals, you will have to take precautions such as wearing sun block. You will be given instructions on how to look after your skin during this time and it is important to follow these to allow your skin to heal properly and avoid complications.

Expectations from treatment

Skin improvements that may result from a peel series

   Softening of fine lines from sun damage

   Diminution of coarse Lines from sun damage

   Increased smoothness in skin texture

   Mild or moderate smoothing of acne scars

   Lightening of pigmentation irregularities

   Increasing skin glow or radiance

   Some minimization of pore size

Speed of improvement needed or wanted

   textural smoothening and improvements with acne prone skin can occur within a month

   deeper textural changes require multiple peels. Noticeable improvements usually occur within 3 months

Amount of healing/ recovery time possible

   no time, back in your routine the day after the peel

   a few days, up to a week

What to expect shortly after the procedure?

   You are likely to experience localised redness and swelling to the treated area

   Rarely pain or tenderness requires painkillers

   Normal activities can be continued

   Rich moisturising cream should be applied for comfort

   DO NOT pick or peel the skin before it is ready to come off, you can trim large areas of peeling skin with clean scissors

   Apply total sun block daily to maintain results

   Rarely the following may happen:

Should you experience any of the above please contact your specialist.

Please remember, that the correction will not last forever, it is therefore advisable to have repeated treatments and use skin care products as advised.

What to do before the peel

At least three to four weeks before the peel you should stop using exfoliating sponges or buff pads and discontinue all forms of hair removal. Avoid shaving the day of the peel.


For 3-7 days after the peel, clean the skin with warm water using the mild liquid cleanser. Use fingertips (not a wash cloth) since the skin is very sensitive at this time. Avoid the use of abrasive or exfoliating sponges.

The skin will turn brown, wrinkle up, and crust, like sunburn.

Do not peel, pick, or scratch the exfoliating skin.

Avoid sun exposure and tanning beds as this can cause discoloration of the new skin. A sunscreen of SPF 30 or higher should be applied every morning before going outdoors. Daily sunscreen use should continue indefinitely to prevent new photo damage from occurring. Make up can be used, but do not cover the entire skin that was treated.

Swelling of the skin following superficial peel in uncommon. Paracetamol or Ibuprofen (200 mg) may be taken 3-4 times daily with food to reduce swelling and discomfort, if needed. Sleep propped up in bed on the first night following treatment.

Contact the specialist if you develop fever, blistering of the treated skin or cold sores.
Touch-ups or a second peel are likely to be needed after the initial peel. Wait at least 4-6 weeks before reapplying the TCA.

Dermal Fillers

A dermal filler is a beauty treatment used to effectively reduce lines, wrinkles and folds in the skin as well as increasing the volume of the skin, giving it an improved and younger appearance. Therefore not only will this improve the way you look but also the way you feel about yourself. I use a variety of fillers which are all non-surgical and give instant, long-lasting and natural looking result.

As well as reducing the depth of nasolabial folds or marionette lines, fillers also can enhance your lips. Fillers will give the lips volume and will define the lip line giving you a younger and more natural look. Fillers can also add volume not just to the lips but to the face generally as well as defining the cheek bone, jaw line and chin to combat signs of ageing.

Your first treatment’s effects usually last between 6 and 12 months although the effects on the lips most frequently last nearer to 6 months. The re-treatment after the 6-12 months retains the effect for approximately a further 18 months.

The photos below show some before and after images: